Research article
Worldwide Variability in Physical Inactivity: A 51-Country Survey

https://doi.org/10.1016/j.amepre.2008.02.013Get rights and content

Background

Physical inactivity is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published.

Objective

To present data on the prevalence of physical inactivity for 51 countries and for different age groups and settings across these countries.

Methods

Data analysis (conducted in 2007) included data from 212,021 adult participants whose questionnaires were culled from 259,526 adult observations from 51 countries participating in the World Health Survey (2002–2003). The validated International Physical Activity Questionnaire (IPAQ) was used to assess days and duration of vigorous, moderate, and walking activities during the last 7 days.

Results

Country prevalence of physical inactivity ranged from 1.6% (Comoros) to 51.7% (Mauritania) for men and from 3.8% (Comoros) to 71.2% (Mauritania) for women. Physical inactivity was generally high for older age groups and lower in rural as compared to urban areas.

Conclusions

Overall, about 15% of men and 20% of women from the 51 countries analyzed here (most of which are developing countries) are at risk for chronic diseases due to physical inactivity. There were substantial variations across countries and settings. The baseline information on the magnitude of the problem of physical inactivity provided by this study can help countries and health policymakers to set up interventions addressing the global chronic disease epidemic.

Introduction

Physical inactivity increases the risk of obesity, coronary heart disease and stroke, and type 2 diabetes, as well as colon and breast cancer, and is therefore recognized as one of the most important modifiable risk factors that is causing the rising global burden of chronic diseases.1, 2, 3, 4 Knowledge of the amount of physical activity performed in different populations worldwide is, however, limited.

Many developing countries lack any data on physical activity levels in their populations.1, 5 Where surveys have been performed, data are difficult, if not impossible, to compare.6, 7 Only a few (mainly European) studies have used the same instrument to assess the prevalence of inactivity or the energy expenditure in a wide range of countries.8, 9, 10, 11

To prevent death and disability from chronic disease caused by physical inactivity, these gaps in knowledge need to be filled and the populations and subgroups at risk need to be identified. Country-level baseline information on the prevalence of physical inactivity is needed for governments to be able to formulate policies and programs aiming at the reduction of physical inactivity.4, 12

This study used data from the World Health Survey to estimate the prevalence of physical inactivity for the populations of 51 countries as well as for different subgroups across the countries. The term physical inactivity was chosen because it closely reflects what has been measured, that is, whether or not a person engages in physical activity. In contrast, sedentary behaviors such as number of hours spent sitting have not been assessed.

Section snippets

Study Population and Design

The World Health Survey, a large cross-sectional study, was launched by the WHO in 2001 and conducted in 70 countries in 2002–2003.13 The included countries were selected because they had a large proportion of the world's population; a wide geographic representation across WHO regions; and a spread among high-, middle-, and low-income countries. Countries could choose from a range of questionnaire modules, one of which contained the questions on physical activity from the International Physical

Response Rates and Demographics

The overall response percentage was 81.7%. Country response percentages (Table 1) ranged from 31.0% (Mali) to 98.6% (Uruguay). The percentage of males in the sample was lowest for Guatemala and the Russian Federation (37.2%) and highest for the United Arab Emirates (72.1%). Mean age ranged from 32.4 years (Kenya) to 45.5 years (Croatia). The percentage of people living in urban areas was lowest for India (10.6%) and highest for the Republic of the Congo (94.3%). This information on setting was

Discussion

This study showed that 17.7% (15.2% of men and 19.8% of women) of a pooled sample of 212,021 individuals from 51 mainly low- and middle-income countries were physically inactive. These numbers are relatively low compared to those in other studies that used similar definitions of physical inactivity and were undertaken during the same years in high-income countries. According to results for 2003 from the Behavioral Risk Factor Surveillance System (BRFSS), 52.8% of U.S. citizens were inactive

Conclusion

This study reports, for the first time, the prevalence of physical inactivity for such a large diversity of countries. For many, physical inactivity data have never been previously reported. Results of this study are, with the exception of six countries, based on nationally representative samples from 51 countries, including 212,021 individuals.

The questionnaire used is one of the only questionnaires specifically designed for the international assessment of physical activity, and was tested for

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